According to the National Library of Medicine, nearly 30% of children suffer from functional constipation. In all likelihood, the percentages are probably higher, as many children and families deal with the condition through home remedies without actually consulting a doctor or scheduling an office visit.

Let’s take a closer look at the causes, symptoms and treatments for constipation in children as well as the main steps toward prevention.

Primary causes

The Mayo Clinic describes constipation as having “infrequent bowel movements or difficult passage of stools that persists for several weeks or longer.” Generally, this translates to a child having three bowel movements or fewer per week.

The primary causes of constipation in youth are as follows:

• Lack of fiber in diet.
• Inadequate hydration.
• Excessive consumption of cow’s milk (greater than 24 ounces in one day).
• Lack of exercise.
• Stool-retaining behaviors.
• Certain genetic disorders, including cystic fibrosis and Down’s syndrome.

When it comes to exercise, I recommend at least one hour of physical activity per day. While all the extra snow and lingering winter weather can put a damper on kids wanting to get outside and play, it’s important to note that indoor exercise and activity also qualify. The main thing is to get up, move around and gain some positive physical activity. 

As for stool-retaining behaviors, sometimes a child who is enjoying playtime may ignore their body’s signals to go to the bathroom. When that happens, the stool can be retained and become dry and hard, making it difficult or painful to pass. This can create a vicious cycle of avoiding the bathroom due to previous negative or painful experiences.

Constipation usually occurs in children over nine months of age. It is especially prevalent during the potty training period as children are just figuring out how to listen and react to their body’s signals. 

Telltale symptoms

Constipation can often slip under the ever-watchful eye of most parents simply because the main symptoms are a bit more under the radar. Depending on the age of the child, parents aren’t necessarily aware of how often they may or may not be going to the bathroom or know the exact results of those visits. 

Parents should look for the following main warning signs that are indicative of constipation in a child:

• Stools that are hard, clumpy or pebble-like.
• Infrequent stooling (less than every 24-48 hours).
• Painful stooling or avoidance/refusal to go to the bathroom.
• Frequent small accidents, which may indicate overflow incontinence.
• Intermittently complaining of abdominal pain.

Suggested treatments

Parents naturally wonder what remedies they can attempt at home to alleviate the symptoms of constipation in their children and at what point they should contact their pediatrician. Those are definitely valid questions.

Hydrate: For starters, parents should make sure the child has access to water at all times. I suggest buying a refillable water bottle and letting the child choose the color or some stickers to help personalize their selection. Encourage them to keep it with them wherever they go and to take sips when feeling thirsty. When children become dehydrated, the body uses the colon as a reservoir and pulls out water, drying out the stool.

Get enough fiber: Parents can increase the amount of fiber in a child’s diet by choosing whole fruits and vegetables to include with every meal and snack. A fun way to do this is to pick items with lots of different colors — such as green cucumbers, yellow peppers, red cherry tomatoes or oranges. Whole fruits are preferable to fruit juices. If your child is picky, don’t be discouraged. Continue to offer a variety of foods at all meals and snacks and celebrate with them when they try something new. Avoid making special meals for picky eaters, as this often serves to reinforce that habit.

Stick to a schedule: Another helpful act is to schedule toilet-sitting times for the affected child. The optimal time to have a child sit on the toilet is within 30 minutes of eating a meal. That’s when the body is likely to signal it is time to go to the bathroom. If the child has been sitting for five minutes with no results, try again after the next meal.

Use positive reinforcement: Be mindful to use positive reinforcement when the child listens to their body’s signals and goes to the bathroom. Throw a mini-celebration! Research has repeatedly shown that positive reinforcements work and negative reinforcements, such as punishment or scolding for having an accident, do not. Avoid insisting on a child stooling or threatening punishments.

If these methods haven’t helped, then it’s time to see your pediatrician. They may recommend some treatments in the appropriate doses for your child’s age and health history.

Common side effects

If left untreated, constipation can lead to significant health problems, including the following:

• Long-term constipation with encopresis.
• Urinary tract infections, caused by impacted stool in the rectum compressing the urinary tract and obstructing the outflow of urine.
• Chronic severe constipation and stretching of the large intestine, which can lead to loss of functional movement of the bowels, requiring hospitalization or surgery.

A complication of constipation is having loose stool accidents known as overflow incontinence. This can manifest as frequent small accidents, sometimes without the child’s knowledge, that can occur multiple times per day. This can be misinterpreted as diarrhea but is actually a sign of severe constipation and is also known as encopresis.

The time it takes to treat constipation completely may depend largely on the severity and length of time a child has had the condition. Children with chronic constipation can return to normal in a matter of months on appropriate therapy. Children who only have constipation once in a while are likely to improve within a week or two with the appropriate therapy.

In conclusion, healthy lifestyle choices — such as frequent hydration, upping your child’s fiber intake and consistent exercise — can prevent constipation and alleviate a lot of stress for parents and children. Parents should not only be in tune with the symptoms of constipation but also feel comfortable checking in with their children often about their bowel movements.

If you have a child who is struggling with constipation, or any other health issues, Utah Valley Pediatrics is here to help. Give us a call to schedule a visit with one of our top-notch pediatricians. We would love to assist!

Dr. Bryan Weed is a pediatrician at Utah Valley Pediatrics, which has nine locations throughout Utah Valley.